Obituary

With the passing of Peter Falk today, I've seen a lot of mentions of his work. Primarily his famous role as Detective Columbo, but also for his movie roles such as "The Princess Bride" and "The In-Laws".

Nowhere in there is anyone mentioning what I thought was a screamingly funny 1990 movie he starred in called "Tune in Tomorrow". It also featured Keanu Reeves.

If you haven't seen it, you should.

Unless, of course, you're Albanian...

Healthy living

Several of my patients are nurses at the hospital I work at. So yesterday afternoon, while I was on rounds, one came over and asked if she could talk to me in private.

So a few minutes later I met her in an empty room. She told me that she found out last week that she's pregnant, and so she stopped her migraine medication. I told her that's fine, and congratulated her.

15 minutes later, while walking out to my car, I noticed her standing outside.

Smoking.

Math

Due to an insane day, I was ordered to stop by Taco Bell to get dinner.

Gumwad: "Welcome to Taco Bell."

Dr. Grumpy: "Hi, can I get the taco party pack for $10?"

Gumwad: "Okay, what size? We have 10 regular tacos for $10, or 12 regular tacos for $10. Your choice."

Reasons I love Annie

Annie: "Dr. Grumpy's office, this is Annie."

Mrs. Somnus: "Hi, I need something to help me sleep."

Annie: "Let me look at your chart... Boy, you've already tried a bunch... Have you been on Dozeaway?"

Mrs. Somnus: "No, but a friend told me it made her too sleepy the next morning, so I don't want that."

Annie: "What about Snorefast?"

Mrs. Somnus: "That's not covered on my plan. Do you have something to help me sleep that's inexpensive and has no side effects?"

Annie: "Buy a teddy bear."

More finding-a-doctor tips

For those of you who missed my previous post on finding a good doc, here's another important clue:

A reputable physician will NOT do office consults and exams at a coffee shop.

Thank you, AM!

Great drug rep quotes

"Doctor, Wirfliss Pharmaceuticals has done a lot of total research on this drug, and we've found that the totality of our results, in total, shows a total number of benefits that improves a patient's total health."

Futility

Dr. Grumpy: "How did the medication work?"

Mr. Metal: "It didn't."

Dr. Grumpy: "How long did you take it for?"

Mr. Metal: "I picked up the bottle."

Dr. Grumpy: "Did you take it?"

Mr. Metal: "Um, no."

Criminal hygiene

Okay, tonight we feature not one, but two memorable criminals.

The first is a dude who picked a really gross place to hide from the police: under a pile of shit in a port-a-potty.

Thank you, Carol!

And second: no matter how good a deal the store may be offering on that fancy mink coat, it may not be worth it. For all you know it's been stuffed up in a lady's crotch for 3 days.

Thank you, Lee!

Dr. Grumpy and Dr. Google

The monthly Costco Connection magazine was left in my lobby recently, and on a quiet day I glanced through it. It featured an article asking whether or not patients should seek medical information online.

Comically, they decided to get pro and con opinions from 2 individuals- NEITHER OF WHOM IS A MEDICAL DOCTOR!

Really. The 2 experts they quoted were Dave deBronkert, who's a "voluntary co-chair for the Society for Participatory Medicine" and Judy Segal, who's an English professor at the University of British Columbia.

Now, I have nothing against either of them. I mean, they are both obviously intelligent, highly educated individuals. But I think it's pretty damn funny that the writer didn't feel it was worthwhile to, say, ask a medical doctor.*

So, Costco mag, here's my 2 cents worth.

First of all, this question is moot. Like atomic energy, cloning, and stem cells, this genie ain't going back in the bottle. People already DO look stuff up online, and unless the internet completely crashes, will continue to do so.

Second: I suppose most of you are expecting me to be adamantly against my patients looking up stuff. But ya know what? I'm not.

Most patients actually DO benefit from learning more about their diseases online. At least half of what I tell them in the office won't get absorbed anyhow. And I don't have the space to keep a million little "Living with Schnorkfloodle's Syndrome" pamphlets lying around. So I refer them to what I consider to be reputable websites (not BigPhilsguidetoParkinsonsDiseaseandroofingmaterials.com).

But there are also the cyberchondriacs. They type a few symptoms into Google, and voila! They are now convinced they have whatever got the most hits (for neurology purposes, I'd estimate that 90% of search engines lead to a self-diagnosis of MS).

It's this group that drives me nuts. They want me to prescribe treatments that are only available somewhere far away (like Senegal). Or they bring in a HUGE stack of information written by a Holostic Reflexologist on a site that has absolutely no valuable medical info at all (but because it has nice graphics it MUST be true). Or they want me to magically enroll them in some study being done in another state that I have absolutely no connection to.

This is where the real problem starts. People who don't have medical knowledge make the scary leap from symptoms, sometime quite vague, to fixating on whatever the internet says they MUST have. Medicine is a process of collecting data from several angles and working out probabilities. If you don't have the training to do that, the information in front of you can be terrifying. Not only that, most people don't understand the difference between various phases of drug trials, so a treatment that's in development suddenly becomes one they think is available.

And here's what really grates me: if these people need a car fixed, they'll do a shitload of research to find a reputable place. They wouldn't dare just grab some random stranger and ask them to repair it. But when they have a health issue they'll take the word of a pet mausoleum architect with a nice internet site over that of a reputable, trained, medical professional.

So here's the take of an uninformed yak herder pretending to be a neurologist: Is it okay for patients to learn about their health issues on the internet? Of course!

As in everything else, though, it depends on the source of the info, the person reading it, and what they do with it.

Let the buyer beware...

*I'm sure I'll hear from those of you who believe this is because we docs are secretly conspiring against you as part of some giant medico-pharma fiendish plot, and therefore can't be trusted.

"Today's forecast: Hot and humid, with a chance of showers"

Thank you, Bob!

Monday morning hospital consult

Never a good sign when the admitting physician's note begins:

"23 year old male, who suffered a head injury while inebriated. He was at a bar, and bit a stripper on the thigh..."

Achievement

With the school year over, Frank and Craig were comparing their Boy Scout award badges. Here are a few:

(click to enlarge)




Yes, folks, the Boy Scouts are now officially awarding an achievement badge for playing videogames.

Memories...

It's not uncommon for realistic families to allow stricken loved ones to die. Sometimes it involves taking them off machines, at others it just means stopping medications.

Years ago I had an older gentleman who'd had a massive stroke, and the family didn't want to have anything done. As always, the question of "how long will he go on?" came up, which is very hard to predict.

Because of the size of the stroke, and him developing brainstem herniation, I guessed about 24-48 hours.

Literally, before I'd finished THAT VERY sentence, he collapsed over to his right and the monitor went flat.

The daughter looked at me, stunned.

All I could say was "And sometimes it's sooner."

Fear

Dr. Grumpy: "Hi, are you the hospitalist seeing my patient, Mrs. Felldown?"

Dr. Hospital: "Yes. I'm sending her to rehab today."

Dr. Grumpy: "Did her tests look okay?"

Dr. Hospital: "I don't know. Do you? I'm busy today."

Dr. Grumpy: "This is Mrs. Felldown we're talking about, right?"

Dr. Hospital: "Yes. What was she admitted for, anyway?"

Dr. Grumpy: "She had a fall."

Dr. Hospital: "Okay. Anyway, I'm going to send her to rehab."

Dr. Grumpy: "Have you seen her yet?"

Dr. Hospital: "No, but the nurse told me she looks fine, and slept well last night."

Dr. Grumpy: "Do me a favor, can you hold her until I can come over and check her out myself?"

Dr. Hospital: "Okay."